1. Boot time only counts if you turn the system off. Most hospitals I work with keep computers up 24-7 and do occasional (~1/day) reboots. Login time is much more important in these hospitals.
2. Ultraportable means that the computers have to be carried around. One of the hospitals I'm at is like that. I refuse to carry around a laptop (it's actually an ultra-portable, slightly bigger than the EEE). Better and easier to audit is just have desktops everywhere (Which is the case in most hospitals I've been to).
3. Agree that wake-from-suspend times are important, not just in laptops but in desktops as well.
4. Interface of the OS doesn't matter. The application should be using up the entire real estate.
As for why EMRs haven't spread, there are a couple tidbits:
1. The security is barely on the radar. Any office that can set up an EMR can do so securely. That's part of the setup costs.
2. There was an interesting case I heard about recently (I'm not sure if it happened in 2007): A cardiology office in one of the south-eastern states of the U.S. data-mined their patients to find out which ones would benefit from implantation of a defibrillator. (This is a fairly expensive procedure that is covered by just about all insurance plans if you meet certain criteria. The doctor can charge the insurance carrier a hefty bill and expect to get paid.) The sudden spike in defibrillator implantations lead to an investigation that revealed that it was due to data-mining of an EMR. Now the office is being sued for not data mining to make sure all their patients are on the right doses of various heart medications. This had a chilling effects that prevented a large group near me from going forward with the translation to an EMR.
3. There is a lot of inertia in paper charts. There is also a great fear in the extra time needed for entering data into an EMR. My office has dedicated transcriptionists and individuals to scan in data. That being said, the entire EMR is managed by our IT guy and we save on "runners" moving charts all over the office and hospitals.
Capitalism is working, only slowly. Open APIs and open source drivers weren't a selling point, so they weren't available. Now with the slowly rising popularity of Linux, and the realization that Linux users are generally more influential in the purchase of hardware than the average buyer, the APIs and drivers will open up.
It's important that we, as a community, reward the good guys (with more purchases) and to let the sales people know why we choose them over their competitors.
That being said, I'm a little ambivalent about the whole AMD/ATI video mess. They've been talking this up for the last year, but have the 3d specs for the hardware been released? Is there a stable opensource driver for Linux even close to the performance of the WinXP/Vista drivers (I don't know).
I'm a doctor who joined a small practice a few years ago. The senior partner of the practice created his own EMR system. It's actually quite good and we use it exclusively. Our office isn't paperless, but everything coming into the office is scanned in or phoned into the virtual fax and never printed. We are able to access it from different offices and from the hospitals we go to via a VPN setup, and it significantly improves our efficiency.
Now the senior partner left. He didn't use a standard database format (but fortunately used Microsoft SQL), and we'll probably have to pay a fortune to have it converted to an open format. Fortunately he's being good about not charging the office for a license for his code, so we have time for the transfer.
One thing about PSP that is nice is the image rotate tool. You basically draw a line in the picture, and it will figure out how much to rotate the image to make the line horizontal. PSP also has some simple vector-type art tools, like drawing lines and arrows and then moving them around and grouping them and things like that.
In my opinion, it's really not competing with photoshop, but is aimed more at the advanced home user that does not want to spend >>$500 for a drawing package.
A 2500x2000 screen is a 5x4 aspect ratio, not 16x9. There must be a lot of cropping off the top and bottom to get a widescreen perspective. In 16x9 mode, you are likely seeing a resolution of about 2500x1400. Still more than enough to do 1080p. Hopefully it has a good upscaling converter hooked up.
I actually have a close friend who has a Littman digital stethoscope. He got it during a cardiology fellowship and used it (with some fanfare) for a couple months. Then he suddenly stopped using it. It turned out that one night while he was on call the battery died and he didn't have a replacement and had to use a standard stethoscope. He realized that he really wasn't getting anything extra from the digital one and it was an extra thing that could fail on him during an emergency.
That being said, I've had a single standard stethoscope fail on me over the course of about 12 years. And that was due to metal fatigue. (The stethoscope was actually much older, probably about 30-35 years old at the time).
The fact of the matter is that in the E.R., the stethoscope has minimal use. No one in their right mind will not do a chest X-ray for someone presenting with shortness of breath. If they miss a tumor or miss-diagnose a pneumonia, their ass gets sued.
Also, the history of the present illness is so important that it trumps just about everything else.
I do agree that some tests are over-ordered, but it's not apparent that cutting down on tests will either improve mortality or decrease total costs to the health care system. (ie: you may miss a diagnosis that causes the individual to die or have a more protracted hospital stay).
That being said, I think that whoever does triage in the hospital E.R. should order the correct tests and not "general battery" on just about everyone. Of course, that means that the person doing triage has to be held accountable for their own actions and opens themselves up for lawsuits (and should be trained and paid accordingly -- ie: not going to happen).
I think the parent was talking about the increased resolution that is possible with digitally enhances stethoscopes. And I agree with him. From a cardiac standpoint, I get 95% of my diagnosis from history and EKG. Add echocardiography and some sort of nuclear stress test will get me up to virtually 100%.
The only time that a stethoscope is of real use to me is in an ICU setting to sort out a post-infarction VSD vs. papillary muscle rupture. And, either way, no one will take an individual to the operating room without a confirmatory echocardiogram, anyway.
Yes, I listen to the heart and do a physical exam, but mostly just to establish my creds with the patient.:-) I get so much more out of a detailed history that I generally tell the patient the plan before I do the physical.
Reminds me of the commercial about the detergent that would get any stain out of carpeting, or your money back. Someone sent in a swatch of carpet "stained" by battery acid. They made a print add out of it about a decade ago. (Sorry, I can't remember the name of the product.)
I'm not sure if it is more intuitive or not. Presumably MSFT has good usability lab to figure that out. It is less destructive, though.
It's been a while since I got burnt by it in nautilus. Does nautilus warn you if it's about to delete the entire contents of a folder because another folder with the same name is being copied over it?
I know that at at least until a year ago, on filesystems that are case retentive but not case sensitive (ie: fat32 and ntfs), nautilus aborts without any warning if it copies a file with the name abc.jpg into the same folder as a file ABC.jpg. (This happens surprisingly often if you have more than one digital camera.) I think it was just fixed in the latest release of the gnome desktop.
I was under the impression that explorer.exe was the MSWindows file manager. As a file manager, it actually is quite nice and has some interesting (good, or at least different) properties compared to nautilus. Such as copying a folder with the same name as a folder in the target will perform a merge of the two folder contents rather than deleting the original contents or the target.
A lot of those people were just doing marijuana. Marijuana is at most as dangerous as alcohol or cigarette smoking. You can't overdose on it. It may cause lung cancer if you smoke it as much as you do cigarettes, but that's almost impossible. The high it gives can be similar to being drunk on alcohol.
On the other hand, marijuana improves appetites in the terminally ill, and may improve tolerance to severe pain in some individuals.
These "warm" bulbs are awesome in the bedroom & hallway, by the way. It's great to turn on the light first thing in the morning and not be blinded, yet 10 seconds later have full lighting in the room.
Give it a break. How many of you have tried alcohol before you hit 21?
I sure did. In fact, my parents were serving themselves and I was a pre-teen. I tried it and didn't like it. I didn't have an interest in alcohol until I was in my mid-twenties. I was also exposed to cigarette smoke before I hit 18, and have no interest to chain-smoke.
I say let parents do some parents and only get into trouble if there is some obvious deleterious issue that manifests itself. If the kid ends up well adjusted, then the parents did fine.
I'm sure as hell going to expose my kids to alcohol before someone else beats me to it. Same goes for violent video games.
Then, the brand goes out of business, I have lost margin and as a small locally owned business have to lay off staff, and there is direct damage to the consumer because next year, Target has moved on, the brand is no longer in business, and I can't get it for my loyal customers. I just started buying at the local Target a few months ago. Do they really leave town that quickly? Isn't the cost of opening up and quickly closing a store of that size pretty enormous? One would think that they would go out of business, in stead of being a large chain.
BTW, I like Target, they have reasonable prices, and I would much rather buy from them than deal with the high markups at a specialty store unless they were adding some value-added services that Target doesn't supply (ie: Custom installation of A/V equipment, rare or out of stock games, etc.)
Slashdot Mirror
To nitpick some of your points:
1. Boot time only counts if you turn the system off. Most hospitals I work with keep computers up 24-7 and do occasional (~1/day) reboots. Login time is much more important in these hospitals.
2. Ultraportable means that the computers have to be carried around. One of the hospitals I'm at is like that. I refuse to carry around a laptop (it's actually an ultra-portable, slightly bigger than the EEE). Better and easier to audit is just have desktops everywhere (Which is the case in most hospitals I've been to).
3. Agree that wake-from-suspend times are important, not just in laptops but in desktops as well.
4. Interface of the OS doesn't matter. The application should be using up the entire real estate.
As for why EMRs haven't spread, there are a couple tidbits:
1. The security is barely on the radar. Any office that can set up an EMR can do so securely. That's part of the setup costs.
2. There was an interesting case I heard about recently (I'm not sure if it happened in 2007): A cardiology office in one of the south-eastern states of the U.S. data-mined their patients to find out which ones would benefit from implantation of a defibrillator. (This is a fairly expensive procedure that is covered by just about all insurance plans if you meet certain criteria. The doctor can charge the insurance carrier a hefty bill and expect to get paid.) The sudden spike in defibrillator implantations lead to an investigation that revealed that it was due to data-mining of an EMR. Now the office is being sued for not data mining to make sure all their patients are on the right doses of various heart medications. This had a chilling effects that prevented a large group near me from going forward with the translation to an EMR.
3. There is a lot of inertia in paper charts. There is also a great fear in the extra time needed for entering data into an EMR. My office has dedicated transcriptionists and individuals to scan in data. That being said, the entire EMR is managed by our IT guy and we save on "runners" moving charts all over the office and hospitals.
Capitalism is working, only slowly. Open APIs and open source drivers weren't a selling point, so they weren't available. Now with the slowly rising popularity of Linux, and the realization that Linux users are generally more influential in the purchase of hardware than the average buyer, the APIs and drivers will open up.
It's important that we, as a community, reward the good guys (with more purchases) and to let the sales people know why we choose them over their competitors.
That being said, I'm a little ambivalent about the whole AMD/ATI video mess. They've been talking this up for the last year, but have the 3d specs for the hardware been released? Is there a stable opensource driver for Linux even close to the performance of the WinXP/Vista drivers (I don't know).
You just described slashdot. Cool.
I'm a doctor who joined a small practice a few years ago. The senior partner of the practice created his own EMR system. It's actually quite good and we use it exclusively. Our office isn't paperless, but everything coming into the office is scanned in or phoned into the virtual fax and never printed. We are able to access it from different offices and from the hospitals we go to via a VPN setup, and it significantly improves our efficiency.
Now the senior partner left. He didn't use a standard database format (but fortunately used Microsoft SQL), and we'll probably have to pay a fortune to have it converted to an open format. Fortunately he's being good about not charging the office for a license for his code, so we have time for the transfer.
One thing about PSP that is nice is the image rotate tool. You basically draw a line in the picture, and it will figure out how much to rotate the image to make the line horizontal. PSP also has some simple vector-type art tools, like drawing lines and arrows and then moving them around and grouping them and things like that.
In my opinion, it's really not competing with photoshop, but is aimed more at the advanced home user that does not want to spend >>$500 for a drawing package.
The problem is: if a bug is noticed in KDE 3.5.x in a couple years, are developers going to waste time fixing it?
Don'y knock PaintShop Pro (PSP). Last time I used PSP (v9), it did a hell of a lot more than The Gimp does now.
There was a guy a while back who put in a bid for 1337 shares at 0.07 cents, or something like that. He may end up owning the entire company. :-)
You do realize that /. originated as "just" Cmdr Taco's blog, right?
10 LTO tapes. I would probably add in 30% redundancy information and create par2 files, and call it a day.
Agree completely. There is something to be said about buying a house and living in it as opposed to upgrading it and selling it in 5-10 years.
Any serious home theater system is going to limit the pool of buyers. That doesn't mean they should never be done.
A 2500x2000 screen is a 5x4 aspect ratio, not 16x9. There must be a lot of cropping off the top and bottom to get a widescreen perspective. In 16x9 mode, you are likely seeing a resolution of about 2500x1400. Still more than enough to do 1080p. Hopefully it has a good upscaling converter hooked up.
I actually have a close friend who has a Littman digital stethoscope. He got it during a cardiology fellowship and used it (with some fanfare) for a couple months. Then he suddenly stopped using it. It turned out that one night while he was on call the battery died and he didn't have a replacement and had to use a standard stethoscope. He realized that he really wasn't getting anything extra from the digital one and it was an extra thing that could fail on him during an emergency.
That being said, I've had a single standard stethoscope fail on me over the course of about 12 years. And that was due to metal fatigue. (The stethoscope was actually much older, probably about 30-35 years old at the time).
The fact of the matter is that in the E.R., the stethoscope has minimal use. No one in their right mind will not do a chest X-ray for someone presenting with shortness of breath. If they miss a tumor or miss-diagnose a pneumonia, their ass gets sued.
Also, the history of the present illness is so important that it trumps just about everything else.
I do agree that some tests are over-ordered, but it's not apparent that cutting down on tests will either improve mortality or decrease total costs to the health care system. (ie: you may miss a diagnosis that causes the individual to die or have a more protracted hospital stay).
That being said, I think that whoever does triage in the hospital E.R. should order the correct tests and not "general battery" on just about everyone. Of course, that means that the person doing triage has to be held accountable for their own actions and opens themselves up for lawsuits (and should be trained and paid accordingly -- ie: not going to happen).
I think the parent was talking about the increased resolution that is possible with digitally enhances stethoscopes. And I agree with him. From a cardiac standpoint, I get 95% of my diagnosis from history and EKG. Add echocardiography and some sort of nuclear stress test will get me up to virtually 100%.
:-) I get so much more out of a detailed history that I generally tell the patient the plan before I do the physical.
The only time that a stethoscope is of real use to me is in an ICU setting to sort out a post-infarction VSD vs. papillary muscle rupture. And, either way, no one will take an individual to the operating room without a confirmatory echocardiogram, anyway.
Yes, I listen to the heart and do a physical exam, but mostly just to establish my creds with the patient.
Reminds me of the commercial about the detergent that would get any stain out of carpeting, or your money back. Someone sent in a swatch of carpet "stained" by battery acid. They made a print add out of it about a decade ago. (Sorry, I can't remember the name of the product.)
I'm not sure if it is more intuitive or not. Presumably MSFT has good usability lab to figure that out. It is less destructive, though.
It's been a while since I got burnt by it in nautilus. Does nautilus warn you if it's about to delete the entire contents of a folder because another folder with the same name is being copied over it?
I know that at at least until a year ago, on filesystems that are case retentive but not case sensitive (ie: fat32 and ntfs), nautilus aborts without any warning if it copies a file with the name abc.jpg into the same folder as a file ABC.jpg. (This happens surprisingly often if you have more than one digital camera.) I think it was just fixed in the latest release of the gnome desktop.
I was under the impression that explorer.exe was the MSWindows file manager. As a file manager, it actually is quite nice and has some interesting (good, or at least different) properties compared to nautilus. Such as copying a folder with the same name as a folder in the target will perform a merge of the two folder contents rather than deleting the original contents or the target.
Don't forget about 15-30 minutes of whatever it takes to make you sweat. Best done in the evening, at least an hour or two before bed.
A lot of those people were just doing marijuana. Marijuana is at most as dangerous as alcohol or cigarette smoking. You can't overdose on it. It may cause lung cancer if you smoke it as much as you do cigarettes, but that's almost impossible. The high it gives can be similar to being drunk on alcohol.
On the other hand, marijuana improves appetites in the terminally ill, and may improve tolerance to severe pain in some individuals.
So, why again is marijuana illegal?
These "warm" bulbs are awesome in the bedroom & hallway, by the way. It's great to turn on the light first thing in the morning and not be blinded, yet 10 seconds later have full lighting in the room.
If those are the fines, the best thing a manager could do is turn a blind eye and let the kids shoplift the games.
Give it a break. How many of you have tried alcohol before you hit 21?
I sure did. In fact, my parents were serving themselves and I was a pre-teen. I tried it and didn't like it. I didn't have an interest in alcohol until I was in my mid-twenties. I was also exposed to cigarette smoke before I hit 18, and have no interest to chain-smoke.
I say let parents do some parents and only get into trouble if there is some obvious deleterious issue that manifests itself. If the kid ends up well adjusted, then the parents did fine.
I'm sure as hell going to expose my kids to alcohol before someone else beats me to it. Same goes for violent video games.
BTW, I like Target, they have reasonable prices, and I would much rather buy from them than deal with the high markups at a specialty store unless they were adding some value-added services that Target doesn't supply (ie: Custom installation of A/V equipment, rare or out of stock games, etc.)